Plantar Vein Thrombosis in the Athletic Population

Background and/or Objectives: Plantar vein thrombosis is a rare vascular condition typically presenting with unilateral plantar foot pain and edema. Of interest to the musculoskeletal clinician, mechanical trauma to the plantar foot, often secondary to athletic activity, has been cited as one of the risk factors for development of these thrombi. The present study aims to assess the demographics, presenting history, risk factors, treatment protocols, and long-term sequelae of patients with plantar vein thrombosis presumed to be secondary to increased mechanical trauma.

Design: Retrospective chart review.

Setting : Tertiary care center.

Participants : Adult patients with mention of plantar vein thrombosis in imaging impressions.

Interventions: Not applicable.

Main Outcome Measures: Primary outcome measure was determination of the demographic and clinical characteristics of plantar vein thrombosis in patients with mechanical trauma as a preceding risk factor. Secondary outcome was evaluation of treatment options in this patient population.

Results: Between 2005 and 2023, thirty-nine patients were diagnosed with plantar vein thrombosis through imaging. Of these thirty-nine patients, nine were determined to have developed due to mechanical trauma. Patients typically presented with plantar foot pain and foot edema. Diagnosis was made via magnetic resonance imaging or compression ultrasound. The most frequent treatment was therapeutic anti-coagulation. Among the population of interest, the only noted complication was propagation of the thrombosis in one patient.

Conclusions: While rare, plantar vein thrombosis should be considered by the musculoskeletal clinician in the differential diagnosis of unilateral plantar foot pain. Development of plantar vein thrombosis secondary to mechanical trauma is likely due to repeated trauma to the plantar veins resulting in endothelial damage and activation of the coagulation cascade. Treatment of these thrombi is most commonly therapeutic anticoagulation, but in the absence of additional high-risk factors serial compression ultrasound may be an adequate first line treatment due to the overall minimal risk of thrombosis propagation.